Erik Zager, DVM, DACVECC, is a board-certified emergency and critical care specialist and head of emergency and critical care at Philadelphia Animal Specialty & Emergency (PASE). He also serves as vice president of Global Instruction for Veterinary Empowerment (GIVE), a nonprofit focused on expanding specialty-level veterinary education worldwide.

On day 1 of the Fetch dvm360 Conference in Long Beach, California, Erik Zager, DVM, DACVECC, opened the event with a keynote focused on the “why” behind clinical choices. Through the lens of a case study on a schnauzer named Panky, he examined common cognitive biases that may lead to suboptimal decision-making in veterinary practice. By being aware of these biases, clinicians can take steps toward preventing or correcting them. Busy clinicians can immediately benefit from clearer decisions that reduce unnecessary tests, lower client cost and anxiety, and focus clinic resources where they improve outcomes.

Zager drew on the work of Nobel laureate Daniel Kahneman, whose book, 

 posits that human thinking is governed by 2 distinct modes: system 1 (fast) and system 2 (slow). System 1 is the fast, automatic, and intuitive mode; it handles effortless tasks such as recognizing a friend's face or making snap judgments. System 2 is the slow, analytical, and effortful mode, which is engaged for complex tasks such as solving a math problem or learning a new skill.

Cognitive biases are features of system 1 thinking. They are the shortcuts the brain uses to save energy and make rapid assessments. They are essential for navigating daily life, but they become problematic when people rely on them for high-stakes decisions that require the slower, more deliberate system 2. “Oftentimes, our brain defaults to system 1 unless we are trying to dial up specifically system 2,” Zager said.

Four biases that influence decision-making

Anchoring bias is the tendency to rely too heavily on the first piece of information offered when making decisions. All subsequent judgments and negotiations are then adjusted based on that initial reference point, which can dramatically skew the final result.

 The first pieces of information the doctor received were "schnauzer" and "day after Thanksgiving." This immediately anchored the doctor's thinking to a common diagnosis for that breed after a holiday: pancreatitis. This anchor caused them to view all subsequent information through that specific lens.

Search satisfaction bias is the tendency to stop searching for answers once one finds an explanation that seems to fit the situation. Instead of treating the first plausible reason as 1 possibility among many, the brain accepts it as the answer, potentially causing the clinician to overlook more complete or accurate information.

 The doctor ran a quick, easy diagnostic test. The result was ambiguous, but it was enough to support the anchored idea of pancreatitis. Satisfied that an answer had been found, the doctor stopped the diagnostic search, ignoring other possibilities and calling the case solved.

Confirmation bias is the powerful tendency to search for, interpret, favor, and recall information in a way that confirms or supports preexisting beliefs or hypotheses. It is much easier for people to accept information that reinforces their worldview than to accept information that challenges it.

 Believing Panky had pancreatitis, the doctor interpreted the ambiguous diagnostic test as "abnormal" because that result confirmed the preexisting theory. Even though the test was objectively normal, the doctor's brain cherry-picked the data that fit the desired narrative.

Outcome bias is the tendency to judge a past decision based on its eventual outcome instead of on the quality of the decision at the time it was made. This is often driven by favoring information that supports a hoped-for outcome, which differs from confirmation bias and reinforces one's existing beliefs.

 The doctor and staff felt stressed by Panky's aggressive behavior and the owner's financial constraints. The hoped-for outcome was to resolve the case quickly and get the dog out of the clinic. This desire drove them to choose the fastest and easiest diagnostic path, rather than the most thorough one, to reach the desired result as quickly as possible.

Cognitive biases are a constant and natural part of how the human brain works, Zager said. The goal is to become aware of them so one can actively engage their more deliberate system 2 thinking when it matters most. Awareness is the first step, but one can also use active "debiasing" strategies to improve decision-making. “I want us to develop, or at least start developing, some of the tools that we can recognize certain automatic thinking and switch it over to a more purposeful thinking that is going to be less prone to these biases," Zager said. Here are a few of the tips he offered.

First, slow down. When a decision is important, consciously engage your slow thinking. The simple act of writing down your thought process, listing pros and cons, or explaining reasoning to someone else forces one to move from a gut instinct to a more deliberate analysis. I'm going to emphasize that effortful thinking that is also deliberate and is less prone to bias,” Zager said.

Share the mental burden by asking colleagues, friends, or partners for their perspective, as they may see things you've missed. Be especially open to those who might disagree with you, as they are most likely to challenge your biases. “It is too much to be thinking this much for every single one of our patients, so ask your colleagues,” Zager said. “And [when] I say colleagues, not just the other doctors, but your technicians [and client service representatives, as well]. They might have gotten information from the owner out front that you might not have had."

Finally, anticipate risks. Actively consider how a decision could go wrong. "Forcing yourself to think about potential negative outcomes helps counter the pull of confirmation bias and outcome bias, which make us focus only on information that supports our beliefs and hopes," Zager said.

By recognizing that these hidden shortcuts exist and actively questioning one’s automatic thoughts, clinicians can make clearer, more deliberate decisions in their work every day.

Zager E. Why and how we choose: rethinking decisions in veterinary practice. Presented at: Fetch dvm360 Conference; December 5-6, 2025; Long Beach, CA.

To read more news and view expert insights from Fetch Long Beach, visit 

’s dedicated site for conference coverage at 

https://www.dvm360.com/conference/fetch-long-beach

Articles

Erik Zager, DVM, DACVECC, kicks off Fetch Long Beach with an evidence-based framework for everyday clinical decision-making.

Four cognitive biases that are short-circuiting your decision-making

Kailana and her siblings when they were younger, would play and roughhouse with each other, like puppies do. When Kailana was 6 weeks old, one of her littermates pulled her down when she was trying to climb out of their enclosure, and she could not move over around 30 seconds. Her owners assumed it was ‘just a stinger, and it appeared to clear up quickly. However, as she continued to grow over the following weeks, John Hartmire and spouse Christine Pobanz-Stelter, Kailana’s owners, noticed she develop abnormalities in her gait.

Kailana received a corpectomy at the William R. Pritchard Veterinary Medical Teaching Hospital at UC Davis after it was discovered she had vertebral malformation. (Image couresty of UC Davis College of Veterinary Medicine) 

“We started noticing her back leg splaying outward, and she would drift as she was running,” said Pobanz-Stelter, in an organizational release.

They brought her to her veterinarian where an X-ray was performed and showed a malformation in her spine. Kailana then had a follow-up with a neurologist, who could not confirm if her condition was from the fall or congenital. He did state that he does not feel it was a hereditary abnormality because none of her littermates experienced any such complications. She was then referred the William R. Pritchard Veterinary Medical Teaching Hospital at UC Davis and was examined by its Neurosurgery Specialty Service.

During her examination at the hospital, Kailana was able to walk independently, but presented with a uncoordinated hind end gait and reduced awareness of where her hind limbs were position in relation to her body.

 The team then brought in the Anesthesia and Diagnostic services to perform a CT, which showed multiple vertebral anomalies from her 4th thoracic vertebrae (T4) to her 9th thoracic vertebrae (T9) (most severe from T5 to T8). This caused marked spinal curvature and spinal cord compression at ^t to T7, and in narrowing of the spinal canal. After learning all of this information, the neurologists now believe her condition is more likely congenital rather than traumatic.

“Given the progressive nature of Kailana’s condition, she would likely lose the ability to walk within a few months,” said Ji-Hey Lim, DVM, PhD, DACVIM (Neurology).

“However, surgical intervention could prevent further neurologic decline and provide long-term improvement in her mobility.”

Believing they could help Kailana walk again, Lim, Adrien Dupanloup, and Vishal Murthy teamed up to perform her surgery.

When Kailana turned 6 months old, Lim proceeded with the surgery. The surgery was a 7-hour operation that involved a corpectomy at the site of the most severe spinal cord compression, which was then followed by stabilization of the spin using pedicle screws and rod. According to the organizational release, corpectomy for congenital vertebral malformations is an especially demanding procedure. The spinal cord is extremely thin at the stenotic site and the bone requiring removal is very close to the this fragile tissue. One small error could cause severe spinal cord damage and paralysis.

Kailana’s surgery was a success, but she was slightly weaker immediately following the surgery. Three days later, she had steadily improved and was discharged home to be on crate rest with restricted activity for a month.

“She’s a 6-month-old puppy so, of course, she wanted to ‘go!’ from the very beginning of her recovery,” said Pobanz-Stelter, explaining the difficulty in keeping her on inactivity and rest. “Keeping her down was near impossible. As soon as we got the go ahead for her to resume activity, she never hesitated.”

Kailana recovery also involved physical therapy where she worked on developing core strength and muscle development. She is doing well, but her owners are still working on it. Now, she enjoys spending time ‘romping’ through the backyard and chasing other dogs, wrestling, and playing fetch.

Warren R. Dog on Brink of Paralyzation Walks After Neurosurgery at UC Davis. School of Veterinary Medicine. November 24, 2025. Accessed December 5, 2025. https://www.vetmed.ucdavis.edu/index.php/news/dog-brink-paralyzation-walks-after-neurosurgery-uc-davis

Successful neurosurgery restores mobility to dog facing paralysis

Health Canada has approved relfovetmab injection (Portela; Zoetis) for alleviating pain associated with feline osteoarthritis (OA). The therapy is designed to reduce OA pain for 3 months with a single injection.

“Health Canada’s approval of [relfovetmab injection] marks a significant step forward in managing osteoarthritis-related pain in cats,” Rob Polzer, PhD, executive vice president and president, research and development for Zoetis, said in a news release.

Zoetis is anticipating relfovetmab injection to be available on the commercial markets in both Canada and Europe in 2026. The therapy received marketing authorization from the European Commission in October 2025. 

A monoclonal antibody (mAb), relfovetmab injection works by targeting anti-nerve growth factor (NGF), a mediator of OA pain and inflammation. “Thanks to [relfovetmab injection’s] long-lasting antibody and its unique binding site to NGF, veterinarians and cat owners in Canada now have a new, innovative way to address osteoarthritis pain,” Polzer said.

Up to 40% of all cats and up to 90% of felines older than 12 years are clinically affected by OA, a common, chronic and progressive joint disease.

 OA leads to inflammation and breakdown of joints, with negative consequences to gait and movement, as well as sleep, relationships and cognition affected by OA-associated pain. Therapies can help reduce pain and mobility issues caused by the disease and improve quality of life for patients.

“[Relfovetmab injection] is…designed to support long-term comfort and mobility for cats—with the added benefit that pet owners only need to bring their cats in for an injection once every 3 months," Richard Goldstein, DVM, DACVIM, DECVIM-CA, global chief medical officer and head of medical affairs at Zoetis, said in a news release.

 "We look forward to providing veterinarians with another innovative tool, adding to our wide feline portfolio, to help them improve the quality of life for the cats in their care."

In earlier 2025, Health Canada also approved Zoetis’ canine mAb therapy designed to reduce pain for 3 months: izenivetmab injection (Lenivia). Like relfovetmab injection, izenivetmab requires a single administration.

Additionally, in November 2025, Zoetis received marketing authorization in Europe for izenivetmab.

 The authorization followed a positive opinion from the Committee for Veterinary Medicinal Products (CVMP) of the European Medicines Agency.

A 9-month field trial in Europe demonstrated effectiveness for relfovetmab injection in alleviating OA pain. Published by the International Renal Interest Society, the study found the therapy to be well tolerated, including by cats identified with kidney disease at IRIS stage 1, 2 or 3.

Zoetis receives Health Canada approval for Portela (relfovetmab injection) to alleviate pain associated with osteoarthritis in cats. News release. Zoetis. December 5, 2025. Accessed December 5, 2025. 

https://news.zoetis.com/press-releases/press-release-details/2025/Zoetis-Receives-Health-Canada-Approval-for-Portelarelfovetmab-injection-to-Alleviate-Pain-Associated-with-Osteoarthritis-in-Cats/default.aspx

Crossley KC. Long-acting therapy for relieving OA pain in cats receives European marketing authorization. 

. October 29, 2025. Accessed December 5, 2025. 

https://www.dvm360.com/view/long-acting-therapy-for-relieving-oa-pain-in-cats-receives-european-marketing-authorization

Enomoto M, Mantyh PW, Murrell J, Innes JF, Lascelles BDX. Anti-nerve growth factor monoclonal antibodies for the control of pain in dogs and cats. 

Slingerland LI, Hazewinkel HAW, Meij BP, Ph. Picavet, G. Voorhout, Cross-sectional study of the prevalence and clinical features of osteoarthritis in 100 cats. 

. 2011;187(3):304-309. doi:10.1016/j.tvjl.2009.12.014

Crossley KC. Novel therapy for canine OA pain gains momentum in global markets. 

. October 16, 2025. Accessed December 5, 2025. 

https://www.dvm360.com/view/novel-therapy-for-managing-canine-oa-pain-gains-momentum-in-global-markets

Crossley KC. Long-acting drug for reducing canine OA pain receives European marketing authorization. 

. November 26, 2025. Accessed December 5, 2025. 

https://www.dvm360.com/view/long-acting-drug-for-relieving-canine-oa-pain-receives-european-marketing-authorization

International Renal Interest Society. IRS staging of CKD. International Renal Interest Society. 2023. Accessed December 5, 2025. 

https://static1.squarespace.com/static/666b9ecb4064a156963b4162/t/66a6dbc90ca6986e1b5c06bd/1722211273243/2_IRIS_Staging_of_CKD_2023.pdf

The monoclonal antibody from Zoetis previously received marketing authorization in Europe.

Health Canada approves novel therapy for managing feline OA

Heidi Lobprise, DVM, DAVDC, shares practical tips and easy-to-use tools to protect soft tissues and improve safety during extractions.

Tips for protecting soft tissues during dental extractions

Heidi Lobprise, DVM, DAVDC, a senior pet advocate and veterinary dental specialist at Cibolo Creek Veterinary Hospital in Boerne, Texas, discusses steps she takes to protect surrounding tissues during dental extractions. She also shares simple tools and positioning strategies that can make extractions safer and more controlled.

The following is a transcript of the video, lightly edited for clarity and cohesion.

 As we're working with these sharpened instruments and our high-speed burs, we do want to be careful about surrounding tissues. As I'm doing a flap, I make sure that when I have my blade and handle, I'm cutting exactly where I want to and hopefully not slip too much. I mean, everybody slips occasionally, but be careful. Anytime I'm holding a periosteal elevator or dental elevator, winged elevator, that instrument is just barely past the tip of my finger, so when I'm using it, if there is some kind of slip, it's not going to go too far. I've got some protection and good control there.

When we're looking at our mandibular teeth, I'm literally using a tongue depressor to depress the tongue. I want to protect the soft tissues from that bur, from my instruments.

Some people will use another instrument to hold back tissue while they're cutting teeth, but that can sometimes injure the instrument, so not a good idea unless you've already messed it up and can use it. We call those “zombies”.

And I also use lip retractors. There are some specific lip retractors that work, or I've used a spiral perm roller that you get at Sally’s Beauty Supply, Walmart, Amazon, wherever, and it can work as a soft mouth gag that also helps keep lips out of the way.

Videos

Heidi Lobprise, DVM, DAVDC, shares practical tips and easy-to-use tools to protect soft tissues and improve safety during extractions, in this interview with dvm360.

Good morning and happy Friday dvm360 readers! Our final Fetch conference of 2025, Fetch Long Beach is kicking off today. We hope all speakers, attendees, and exhibitors have a week full of fun, learning, networking, and more! Can’t make it to this year’s Fetch Long Beach? Don’t worry we kick off our Fetch conferences for 2026 in March with Fetch Charlotte, and registration is open for that!

However, if you wanted to get CE to end your year and can’t make Fetch Long Beach, dvm360’s first Fetch Encore is kicking off on December 14, 2025! Join dvm360 and veterinary leaders for a day full of feline fun! You can learn more about the virtual event, including where to register, 

For in between sessions at Fetch Long Beach, or to just catch up on the news from the week, here is what dvm360 covered this week:

Fluralaner topical solution (Exzolt Cattle-CA1; Intervet Inc.) received 

 from the FDA for prevention and treatment of New World screwwormlarval infestations as well as treating and controlling cattle fever tick in beef cattle over 2 months of age, and replacement dairy heifers less than 20 months old.

 earlier this month by performing the countries first successful pacemaker implantation in a feline patient after Pepsi, an 8-year-old domestic shorthair cat, suffered from severe cardiac arrythmia that caused her to have frequent fainting spells.

 of The Vet Blast Podcast presented by dvm360, our host Adam Christman, DVM, MBA, sat down with Hunter Finn, DVM, and Noga Schiller, DVM, to take a deep dive in vaccine tittering, including advantages of in-house tests, how it can create personalized vaccination decisions, enhance pet care, and more.

Are you heading to Fetch Long Beach this weekend, but don’t know where to start with picking out which lectures to go to? Don’t worry, dvm360 has your back.Check out these 

 our editors are excited about this weekend!

Serenity Vet, a veterinary relief management platform, officially launched a 

 that allows clinics and hospitals to manage relief veterinary staffing by seeing their availability in real time as well as scheduling, booking, and compensation payments.

, the agency issued a draft guidance identify specific types of monoclonal antibody products it believes 6-month toxicity resting in nonhuman primates can be reduced or eliminated. This draft guidance is part of the FDA’s work to modernize nonclinical evaluation and reduce animal testing.

Wrap up: Topical drug to prevent and treat New World screwworm in cattle receives conditionally approval, and other news

Cynthia Otto explains Penn Vet research into hyperthermia

Alternative techniques to the voluntary head dunk and what's next

Cynthia M. Otto, DVM, PhD, DACVECC, DACVSMR, expands on research conducted by the Penn Vet Working Dog Center research. She walks through alternative techniques to the voluntary head dunk, explains when to avoid it, and shares what they're planning to examine next.

Cynthia M. Otto reports research showing the benefits of a trained head dunk to prevent heat stroke in dogs

Cynthia M. Otto, DVM, PhD, DACVECC, DACVSMR

: It's not one size fits all. As I mentioned before, if a dog is already showing signs of heat injury—heading into heat stroke—or is mentally inappropriate, it's not going to be safe to attempt some of the techniques we've studied. Above all, it's about keeping the dog safe. If a dog is too hot and can't stop panting, they may not be able to tolerate dunking their head; that's when we need to hose them down or immerse them in a pool for complete immersion, and get them to veterinary care if indicated.

Most of the time, though, these methods are field cooling: cool them off, give them a break, and let them return to whatever they were doing. This is preventive care, not emergency care, and it's important to keep that distinction in mind when discussing cooling in the veterinary hospital.

If a dog has debris in their eyes or you want to flush their eyes, that's straightforward and useful. One group we haven't tested well are brachycephalic breeds; they may still benefit, but we don't yet have data. The dogs we've worked with so far are working-breed dogs—labs and shepherds—with more standard anatomy.

Water should be clean, and water temperature matters. We know the method is effective at about 72 °F. If the water is warmer, you won't get as much benefit because you need the water to be cool enough to allow heat transfer.

This past summer we ran a follow-up study because people asked whether you must train a dog to "head dunk," or whether other approaches—like a cold, wet towel wrapped around the head—would be similarly effective. That study is still under analysis, but our initial data suggest that the soaked-towel method is not effective at reproducing the cooling of a head dunk. We still need to finalize the analysis and publish the results.

We also compared colder water to room-temperature water. We tested approximately 59°F—basically groundwater from a well—versus 72°F, our room-temperature condition. We evaluated the head dunk at both temperatures, the towel at both temperatures, and pool immersion. We also looked at dogs standing in a pool versus lying down; not all dogs will lie down, and for total-body immersion we ideally want them to lie down, but many won't.

We also considered drinking. Does drinking cold water help? People naturally drink when they're hot, but dogs drinking excessive volumes raises concerns like bloat, so we need to analyze that data carefully. Questions such as whether 59 °F versus 72 °F makes a meaningful difference will be answered when the analysis is complete.

Another part of our ongoing work is how best to measure temperature. We evaluated subcutaneous (sub-Q) temperature chips, ingested temperature pills, and ear temperature...each has limitations. That raises the question of whether the absolute number matters as much as how the dog is responding physiologically. In many cases, the dog's clinical response and physiology will be more important than any single recorded temperature, because numbers can vary depending on the measurement method.

Cynthia M. Otto, DVM, PhD, DACVECC, DACVSMR, explains what competing techniques the research team looked at and how they can further this research.